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Biomedical subjects

A Burns

Publications and source records attributed to A Burns.

At least 109 records · Page 6Linked to original sources
PubMed1997

Heterogeneity in intensive care units: fact or fiction?

Reports and guidelines concerning intensive care practice have been issued recently. However, the introduction of such centrally issued recommendations may be difficult because of marked heterogeneity between intensive care units. This study examined the facilities (number of beds, consultant sessions, nursing establishment), annual workload (number and types of patients admitted) and outcome (intensive care unit mortality) in the (old) Anglia Region. There were significant differences in the distribution of patients' ages, severities of illness, diagnoses, durations of admission and outcomes. Such heterogeneity may make multicentre trials more difficult to conduct and create problems when uniform measures designed to improve intensive care services are being planned.

APACHE↗
PubMed1997

Two teenagers, traumatic aortic disruption, and transoesophageal echocardiography.

A report of two teenagers is presented who were passengers of the same vehicle when it was involved in a serious road traffic accident. Their vehicle was hit on the side at high speed by a second vehicle. Both teenagers sustained multiple injuries. On arrival at a district general hospital they required resuscitation, exploratory laparotomies, and postoperative intensive care. Neither had radiographic evidence to suggest any mediastinal injury, but transoesophageal echocardiography demonstrated aortic disruption in both patients. They were transferred to a regional cardiothoracic centre where their lesions were successfully repaired and both have made a full recovery.

Accidents, Traffic↗
PubMed1997

The impact of the symptoms of dementia on caregivers.

BACKGROUND: The symptoms of dementia are the most obvious stressors to which caregivers are exposed and many studies have investigated the association of such symptoms with the adverse consequences of caring. The present paper represents the only dedicated review of this literature. METHOD: Manual and computer (MEDLINE) literature searches were performed. RESULTS: Seventeen empirical studies were found. CONCLUSIONS: Variability in conceptual and methodological approaches and inconsistencies in the reported findings have prevented firm conclusions from being drawn. However, the literature provided support for a relationship between non-cognitive features in dementia and psychological problems in caregivers, and suggested possible associations between cognitive deficits and some negative care-giver outcomes. New methodological and conceptual approaches are required if decisive evidence is to be forthcoming. This information is a prerequisite for investigations into the causal mechanisms that sustain these relationships, and for rationally designed interventions.

Activities of Daily Living↗
PubMed1997

Apolipoprotein E genotypes and serum lipid levels in Alzheimer's disease and multi-infarct dementia.

OBJECTIVE: Assessment of apolipoprotein E genotype, serum cholesterol, triglycerides, high density lipoprotein-cholesterol and low density lipoprotein-cholesterol levels in different types of dementia. SUBJECTS: 102 consecutive referrals to an old age psychiatry service based at Manchester were classified according to clinical criteria based on ICD 10. RESULTS: Thirty-seven were considered to have Alzheimer's disease, 16 multi-infarct dementia and 33 to be free from dementia. Sixteen patients, in whom a definitive diagnosis could not be reached or sufficient information was not available, were excluded from the study. There was an increase in the prevalence of the Apo E4 allele in both Alzheimer's disease (chi 2 = 3.82, p < 0.05) and multi-infarct dementia (chi 2 = 1.93, p < 0. = 0.16) by Wald tests compared to individuals without dementia. The increased prevalence of the E4 Allele in multi-infarct dementia was not related to serum lipid levels. CONCLUSION: The hypothesis that the onset of multi-infarct dementia may be precipitated by E4's mediation of higher serum cholesterol levels is not supported by the present study.

Aged↗
PubMed1997

Depression in dementia: a study of mood in a community sample and referrals to a community service.

The association between degree of cognitive impairment and severity of depressive symptoms was examined in a randomly selected community-based sample of elderly people and in a sample of patients referred to an old age psychiatry service. Findings contradict previous reports of less cognitive impairment in demented patients with depressive symptoms. We suggest that sample selection bias has contributed to the earlier reports.

Affect↗
PubMed1997

Manchester and Oxford University Scale for the psychopathological assessment of dementia.

There is increasing awareness of the importance of psychopathological and behavioral changes in dementia and a need for a technique to measure these noncognitive features. Such a schedule should keep screening questions to a minimum, include a severity measure, exclude symptoms resulting from physical illness, be as brief as possible, and not mix domains of psychopathology. To test the reliability, sensitivity, and validity of a newly developed test, 30 carers were interviewed four times during 6 weeks. An obligatory stem question in each category was followed by supplementary questions. The interviewer recorded the presence of each symptom, its severity, when each symptom started, its duration, and whether it was still present. To detect the presence of delusions, the informant was asked about the patient's insight. Satisfactory differences in mean kappa values were demonstrated in test-retest and interrater reliability and validity compared with other techniques. This test may be useful to measure the outcome of drug trials, for correlating psychopathological and behavioral changes with autopsy findings and in epidemiological surveys.

Aged↗
PubMed1996

Psychiatric symptoms and behavioral disturbances in dementia: a review of therapy.

Psychiatric symptoms and behavioral disturbances in dementia (sometimes referred to as noncognitive features of dementia or neuropsychiatric symptoms) are important aspects of the clinical syndrome of dementia. Despite their significance, there have been few studies concentrating on these features from the viewpoint of therapy. This article reviews some of the studies that have been carried out. For more detailed reviews, the reader is referred to Schneider and Sobin (1994) and Burns (1994).

Behavior Therapy↗
PubMed1996

Do glomerular atherosclerosis and lipid-mediated tubulo-interstitial disease cause progressive renal failure in man?

The nephrotic syndrome presents the kidney with a new environment in which blood vessels, glomerular structures and tubules are exposed over substantial periods of time to lipoproteins. LDL has charge affinity with glomerular basement membrane glycosaminoglycans, so potentially increases or maintains albumin loss. This in turn stimulates LDL synthesis. HDL is small enough to be passed by the glomerular filter in substantial amounts and has been found to stimulate endothelin-1 production by human proximal tubular cells in culture. LDL also inhibits nitric oxide vasodilatory responses, an action which when added to that of endothelin-1 may result in decreased renal tissue oxygenation. Taken together, these aspects of the nephrotic syndrome broaden conventional definitions of atherosclerosis and offer a number of targets for therapy in progressive renal disease.

Arteriosclerosis↗
PubMed1996

Manchester and Oxford Universities Scale for the Psychopathological Assessment of Dementia (MOUSEPAD).

BACKGROUND: There is increasing awareness of the importance of psychopathological and behavioural changes in dementia and a need for an instrument to measure these features which achieves an appropriate compromise between brevity and breadth. We describe a newly developed 59-item instrument: the MOUSEPAD. METHOD: Reliability, sensitivity and validity were examined with 30 carers, each of whom was interviewed four times over six weeks. RESULTS: For different symptom groups, kappa ranged from 0.43 to 0.93 for test-retest reliability, from 0.56 to 1.0 for inter-rater reliability, and from 0.43 to 0.67 for the validation study. CONCLUSIONS: The scale may be useful as an outcome measure in drug trials, for correlating psychopathological and behavioural changes with post-mortem findings, and in epidemiological surveys.

Aged↗
PubMed1996

Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop.

Recent neuropathologic autopsy studies found that 15 to 25% of elderly demented patients have Lewy bodies (LB) in their brainstem and cortex, and in hospital series this may constitute the most common pathologic subgroup after pure Alzheimer's disease (AD). The Consortium on Dementia with Lewy bodies met to establish consensus guidelines for the clinical diagnosis of dementia with Lewy bodies (DLB) and to establish a common framework for the assessment and characterization of pathologic lesions at autopsy. The importance of accurate antemortem diagnosis of DLB includes a characteristic and often rapidly progressive clinical syndrome, a need for particular caution with neuroleptic medication, and the possibility that DLB patients may be particularly responsive to cholinesterase inhibitors. We identified progressive disabling mental impairment progressing to dementia as the central feature of DLB. Attentional impairments and disproportionate problem solving and visuospatial difficulties are often early and prominent. Fluctuation in cognitive function, persistent well-formed visual hallucinations, and spontaneous motor features of parkinsonism are core features with diagnostic significance in discriminating DLB from AD and other dementias. Appropriate clinical methods for eliciting these key symptoms are described. Brainstem or cortical LB are the only features considered essential for a pathologic diagnosis of DLB, although Lewy-related neurites, Alzheimer pathology, and spongiform change may also be seen. We identified optimal staining methods for each of these and devised a protocol for the evaluation of cortical LB frequency based on a brain sampling procedure consistent with CERAD. This allows cases to be classified into brainstem predominant, limbic (transitional), and neocortical subtypes, using a simple scoring system based on the relative distribution of semiquantitative LB counts. Alzheimer pathology is also frequently present in DLB, usually as diffuse or neuritic plaques, neocortical neurofibrillary tangles being much less common. The precise nosological relationship between DLB and AD remains uncertain, as does that between DLB and patients with Parkinson's disease who subsequently develop neuropsychiatric features. Finally, we recommend procedures for the selective sampling and storage of frozen tissue for a variety of neurochemical assays, which together with developments in molecular genetics, should assist future refinements of diagnosis and classification.

Dementia↗
PubMed1995

Properties of human affect induced by static color slides (IAPS): dimensional, categorical and electromyographic analysis.

Human affect elicited by static color slides was evaluated quantitatively using dimensional (N = 60 subjects) and differential or categorical (N = 57) self report, and facial electromyography (N = 20). Mean dimensional self reports of affective responses were highly replicable across cohorts. Mean categorical response profiles over seven affective categories were monomodal for some slides, but multimodal for most, and nearly identical within the same cohort for slides of similar content. Mean categorical response profiles for individual slides were also similar across different cohorts and for different experimental conditions. Valence calculated from weighted categorical self report scores was highly correlated with the self reported valence (r = +0.98), demonstrating a simple, linear relationship between dimensional and categorical (differential) measures of affect. Categorical response strength was synergically patterned, i.e. invariably correlated positively for affect of the same dimensional valence and generally correlated negatively for affect of opposite valence. Facial electromyograms associated with affective responses to slides were correlated with valence, but smaller in magnitude than those associated with the weakest possible voluntary facial movements involving the same muscles. This study, therefore, demonstrates that self reported affective responses to color IAPS slides are replicable within and between cohorts, complex but synergically patterned, and relatively weak.

Affect↗
PubMed1995

Neuronal factors influencing the decision to swim in the medicinal leech.

The initiation of leech (Hirudo medicinalis) swimming in isolated segmental nerve cord preparations requires only excitation of segmental swim gating and swim oscillatory interneurons. However, several observations indicate that when the entire isolated central nervous system (head ganglion through tail ganglion) is used, neuronal inputs from the head ganglion other than excitatory inputs to the segmental swim-generating network influence whether swimming results in response to a given stimulus. In this study, experiments were performed to demonstrate that the initiation of swimming is controlled by two parallel pathways emanating from the head ganglion that have opposite effects on the segmental swim-generating network. One pathway, the swim-activating system, excites the segmental swim-generating network, while the other pathway, the swim-inactivating system, suppresses it. The balance between the effects that the swim-activating and inactivating systems have on the segmental swim-generating network determines whether swimming occurs. Moreover, we identified a pair of interneurons, cells SIN1, in the leech head ganglion whose spiking activity must be suppressed in order for swimming to be initiated since their activity is incompatible with swimming. Depolarization of cell SIN1 during swimming indirectly inhibits segmental swim-gating interneurons and terminates ongoing swimming activity. Thus, cells SIN1 are most likely part of the swim-inactivating system in the leech head ganglion.

Animals↗
PubMed1995

Effect of conjugation methodology, carrier protein, and adjuvants on the immune response to Staphylococcus aureus capsular polysaccharides.

Conjugate vaccines were prepared with S. aureus type 8 capsular polysaccharide (CP) using three carrier proteins: Pseudomonas aeruginosa exotoxin A (ETA), a non-toxic recombinant ETA (rEPA), and diphtheria toxoid (DTd). Adipic acid dihydrazide (ADH) or N-succinimidyl 3-(2-pyridyldithio) propionate (SPDP) was used as a spacer to link the CP to carrier protein. All conjugates gave a high immune response with a boost after the second immunization. Conjugates prepared with ADH gave higher antibody titers than conjugates prepared with SPDP. IgG1 was the primary subclass elicited by all conjugates regardless of the carrier protein or the conjugation method used to prepare the vaccines. The non-immunogenic CP and the conjugates were formulated with either monophosphoryl lipid A (MPL), QS21, or in Novasomes and evaluated in mice. While the adjuvants failed to improve the immunogenicity of the nonconjugated CP, a more than fivefold increase in the antibody levels was observed when these adjuvants were used with the conjugates. Significant rises in IgG2b and IgG3 were observed with all formulations. The enhancement of the immunogenicity and the IgG subclass shift, as seen with some adjuvants, may prove to be important in immunocompromised patients.

ADP Ribose Transferases↗